International Journal of
Environmental Research
and Public Health
Article
Work-Related Injuries among Insured Construction Workers
Presenting to a Swiss Adult Emergency Department: A
Retrospective Study (2016–2020)
Ralf Dethlefsen 1,† , Luisa Orlik 2,† , Martin Müller 3 , Aristomenis K. Exadaktylos 3 , Stefan M. Scholz 4,5 ,
Jolanta Klukowska-Rötzler 3,‡ and Mairi Ziaka 2, *,‡
Citation: Dethlefsen, R.; Orlik, L.;
Müller, M.; Exadaktylos, A.K.; Scholz,
S.M.; Klukowska-Rötzler, J.; Ziaka, M.
Work-Related Injuries among Insured
Construction Workers Presenting to a
Swiss Adult Emergency Department:
A Retrospective Study (2016–2020).
Int. J. Environ. Res. Public Health 2022,
19, 11294. https://doi.org/10.3390/
ijerph191811294
Academic Editor: Paul B. Tchounwou
Received: 2 August 2022
Accepted: 3 September 2022
Published: 8 September 2022
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distributed under the terms and
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Attribution (CC BY) license (https://
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4.0/).
Int. J. Environ. Res. Public Health 2022, 19, 11294. https://doi.org/10.3390/ijerph191811294
1 Department of Orthopedics, Thun General Hospital, 3600 Thun, Switzerland
2 Department of Internal Medicine, Thun General Hospital, 3600 Thun, Switzerland
3 Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University,
3010 Berne, Switzerland
4 Department of Statistics, Suva (Swiss National Accident Insurance Fund), 6002 Lucerne, Switzerland
5 Central Office for Statistics in Accident Insurance (SSUV), 6002 Lucerne, Switzerland
* Correspondence: mairi.ziaka@gmail.com; Tel.: +41-58-636-29-70
† These authors contributed equally to this work.
‡ These authors contributed equally to this work.
Abstract: Occupational injuries are one of the main causes of Emergency Department visits and
represent a substantial source of disability or even death. However, the published studies and reports
on construction–occupational accidents in Switzerland are limited. We aimed to investigate the
epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age
over a 5-year period. Data were gathered from the emergency department (ED) of Bern University
Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents
between 2016–2020. A total of 397 patients were enrolled. Compared to studies in other countries,
we also showed that the upper extremity and falling from height is the most common injured body
part and mechanism of injury. Furthermore, we were able to show that the most common age group
representing was 26–35 years and the second common body part injured was the head, which is
a difference from studies in other countries. Wound lacerations were the most common type of
injury, followed by joint distortions. By stratifying according to the season, occupational injuries
among construction workers were found to be significant higher during summer and autumn. As
work-related injuries among construction workers are becoming more common, prevention strategies
and safety instructions must be optimized.
Keywords: work-related injuries; adult emergency department; Suva; construction site accidents
1. Introduction
Occupational diseases have been a concern of health professionals since antiquity:
Hippocrates recognized the toxicity of lead in mining workers in the 4th century BC [1]. An
occupational injury is defined as any type of injury associated to the course of work, which
could result from physical, biological, chemical, or psychosocial hazards [2]. Moreover, an
occupational accident is described as an unexpected and unplanned occurrence arising at
or in the course of work leading to death, personal injury, or disease [3].
Occupational injuries are one of the main causes of Emergency Department visits
and represent a substantial source of disability or even death, especially among young
adults [4,5]. Indeed, according to the International Labour Organization, 2.78 million
workers suffer fatal work-related injuries and occupational diseases annually. Additionally,
each year non-fatal accidents are reported in 374 million workers [6]. It is, moreover,
estimated that work-related injuries lead to a global economic loss of 4% [6], making them
the second-highest health-care cost in the United States [7].
https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 11294 2 of 16

In various epidemiological studies, a wide range of contributing determinants has been

identified and include work-related risk factors such as type of occupation, environmental
factors, limited work experience, shift work, overtime, and physical stress [8–10]. Moreover,
non-work-related factors, as for example sociodemographics (e.g., young age group, male
gender), health-related risk factors (e.g., smoking, obesity, physical inactivity, alcohol
consumption), and prior medical conditions appear to be additionally associated to work-
related injuries [10].
Regarding the type of occupation, the construction industry has globally the highest ac-
cident rates, making it one of the most dangerous sectors [11]. Fabiano and co-workers [12]
investigated the trends of occupational injuries among temporary workers in Italian indus-
tries and found that the construction sector has one of the highest risks for work-related
injuries. Similar results were reported by Unsar et al., who studied the epidemiology of
occupational injuries in Turkey between 2000 and 2005. The study highlighted the construc-
tion industry as one of the most common occupations associated with accidents, being in
fact the most common in terms of fatal occupational accidents [13]. This is in accordance
with recent research regarding work-related fatal injuries in Italy, which has demonstrated
construction as the occupation with the most fatal injuries [14,15]. Indeed, the construction
industry is simultaneously dynamic and vulnerable, and highly affected by environmental
and geographical factors [16,17]. Nevertheless, the interaction between professionals from
different disciplines, companies, and countries generates a heterogeneous environment af-
fecting accident rates [18–20]. Moreover, indicators such as working with heavy equipment,
working at heights, falling objects, noise, and vibrations act cumulative to the increase of
frequency and severity of accidents on construction sites [17,21]. Furthermore, previous
research has highlighted that geographical disadvantages such as working in mountainous
and river regions significantly affect the possibility of accidents on construction sites [17].
In addition, climate factors such as rain, wind, light levels, and high environmental tem-
peratures have been strongly associated with a surge in both frequency and magnitude of
events on construction sites [22]. Common causes of accidents among construction workers
include contact with objects —especially cutting or piercing objects— falls, overexertion,
exposure to hazardous materials, and electrical shock [23–26]; often several events are
involved [25]. Related to the type of injury strains and sprains, cuts and lacerations, fractures,
and contusions represent the most common types of injury. However, construction accidents
can lead to more severe injuries as well with burns, amputations, traumatic brain injury,
and lacerations of internal organs, additionally leading to fatal outcomes [23–26]. Lastly,
despite significant improvements in safety performance over the past decades, health and
safety training among construction workers are commonly inadequate due to the lack of
appropriate procedures and guidelines [27,28].
Based on the fact that construction industry is growing rapidly, the socioeconomic
influence of work-related accidents is snowballing [16]. Indeed, the construction sector
plays a fundamental role in the global economy providing millions of jobs globally and
represents 6% of the world’s gross domestic product, while it is estimated to increase
significantly in the next years [29].
Considering that the probability of a serious accident in the construction sector is
2.5 times higher than in other industries and that globally 30–40% of these accidents are
fatal, the socio-financial consequences can be devastating. In particular, accidental events
at the construction site cause disabilities and affect the integrity of employees and their
families, performance of the rest of the workers, and project productivity [30]. Thus, it is
necessary to reduce rates of accidents on construction sites by establishing strategies and
safety measures.
Despite the accuracy of collected data regarding construction accidents by Suva In-
surance (Schweizerische Unfallversicherungsanstalt—Swiss National Accident Insurance
Fund), very limited data evaluating patients presented to the emergency departments with
a construction-accident related injury exist in Switzerland. Hence, we aimed to investigate
the epidemiology of fatal and non-fatal injuries among construction-workers over a 5-year
Int. J. Environ. Res. Public Health 2022, 19, 11294 3 of 16

period (i.e., from January 2016 until December 2020) on a retrospective basis in order to
identify current trends with regard to year, age groups, and season, and identify possible
causes, risk factors, underlying mechanisms, and trauma patterns. Moreover, we focused
on the occurrence of injuries as a function of demographic characteristics, such as age and
gender, as a means to suggest further prevention strategies and safety instruction protocols.

2. Methods and Materials

2.1. Design
This is a retrospective, longitudinal study of all patients who were referred to the
Department of Emergency Medicine for Adults of the Inselspital, Bern University Hospital,
Switzerland, one of the Level 1 Trauma centers (50,000 patients per year, catchment area
of 2 million inhabitants) in Switzerland, between 2016 and 2020 after a work-related
accident on a construction site and who were covered by Suva Insurance (Schweizerische
Unfallversicherungsanstalt—Swiss National Accident Insurance Fund).

2.2. Database Search Criteria

The medical report database of the Inselspital Bern (category: University Emergency
Center) was searched using the following search term: “construction site” (original in
German: «Baustelle»). The medical ED report of every hit in our computerized database
(Ecare, Turnhout, Belgium) was then manually screened to ensure that trauma on the
construction site was present.
Information found in the emergency medicine reports fitting the mentioned search
term was then exported. Initially, this medical database included 1202 patients. After the
application of our exclusion criteria, 397 subjects remained.

2.3. Recruitment of Patients

2.3.1. Inclusion Criteria
All patients with a construction-related accident extracted from the cohort between
2016 to 2020 were included in the study.

2.3.2. Exclusion Criteria

Patients who were not covered by Suva insurance were excluded from the study.
According to the Swiss Accident Insurance Law (German: Unfallversicherungsgesetz,
UVG), all employees working in Switzerland are compulsorily insured against accidents
and occupational diseases. Suva is part of the Swiss social insurance system and all
Swiss companies in the industry and construction sector are legally obligate to have their
employees covered by Suva. Construction workers who are employed by foreign companies
are not covered by Suva and therefore excluded, as well as patients who have not been
employed at all, i.e., had an accident on their own, private construction site. Due to the
retrospective design of our study, it is impossible to distinguish whether a patient had an
accident on his own, private construction site, or was employed by a company from abroad:
a questionnaire in the context of a prospective study would allow to identify and classify
those patients correctly. For this reason, we have only included patients who are insured
by Suva.
Moreover, we had to exclude some patients whose clinical data were not complete and
thus not suitable for statistical testing. If patients had not signed the general consent by
the Inselspital in order to enable scientists to use personal health-related data for research
purposes they were also excluded. Children and people younger than 16 years of age were
not taken into account. In total, 397 patients with sufficient clinical and demographic data
were finally included (Figure 1).
 Moreover, we had to exclude some patients whose clinical data were not complete
and thus not suitable for statistical testing. If patients had not signed the general consent
by the Inselspital in order to enable scientists to use personal health-related data for re-
search purposes they were also excluded. Children and people younger than 16 years of
Int. J. Environ. Res. Public Health 2022,age
19, 11294 4 of 16
were not taken into account. In total, 397 patients with sufficient clinical and demo-
graphic data were finally included (Figure 1).

Figure 1. Flow
Figure 1. Flow chart
chart of
of medical
medical record
record selection.
selection.
2.4. Demographic and Clinical Data
2.4. Demographic and Clinical Data
Our data were extracted from the consilia addressed to the general practitioners that
Our data were extracted from the consilia addressed to the general practitioners that
comprised detailed clinical and radiographic descriptions available in electronic form. The
comprised detailed clinical and radiographic descriptions available in electronic form.
following demographic and clinical data were collected:
The following demographic and clinical data were collected:
1. General patient data:
1. General patient data:
a. Gender
a.
b. Gender
Age
b. Age
2. Admission and discharge data:
2. Admission and discharge data:
a. Route of admission
a.
b. Route
Date of
of admission
admission: weekday, month, season
b.
c. Date
Time of admissionweekday,
of admission: month, season
(morning/afternoon/evening/night and whether immedi-
ately after the accident to X number of days after the accident)
d. Triage levels
e. Treatment area in the ER and whether trauma room treatment took place
f. Route of discharge
Int. J. Environ. Res. Public Health 2022, 19, 11294 5 of 16

3. Admission department and hospitalization duration if hospitalized

a. Anamnestic data:
I. Occupation/activity performed
II. Accident mechanism
III. Fall (height, object causing the fall, landing area)
IV. machine handling/driving a transport vehicle
V. Working with manual instruments
VI. transport by hand (lift weight)
VII. Moving (walking, running, climbing, tripping)
VIII. Contaminating substances/explosion, burn, electrical contact
IX. Being hit by a car, being run over
X. Entrapment/impact against object
XI. Cut on an object
b. Objects causing accident:
I. Terrain
II. Material extraction
III. Electricity
IV. Machines/manual instruments
V. Conveyor system
VI. Means of transportation (driving vehicle, trailer)
VII. Harmful, flammable or explosive substances/gases and dust
VIII. Foreign body splinters
IX. Humans and animals
c. Location of accident:
I. Building construction site
II. Road construction site
III. Excavation pit
4. Clinical and preclinical data:
a. Injury type (simple injury, combined injury, polytrauma)
b. Type of injury:
I. Wound laceration, incl. internal organs, pneumothorax
II. Cerebral commotio, cerebral hemorrhage
III. Distortion, contusion, crush trauma
IV. Closed or open fracture, dislocation, amputation
V. Burn, frostbite
VI. Chemical burns, electric shock, chemical substances, etc.
VII. Infection, poisoning, irritation of mucous membranes
VIII. Foreign body penetration, foreign body irritation
c. Treatment method: Conservative, surgical, minimally invasive, death in emer-
gency room
d. Injured body site: Head, neck, spine, thorax (and thoracic organs), back, ab-
domen (and abdominal organs), pelvis, shoulder, upper arm, elbow, forearm,
wrist, hand, hip joint, thigh, knee joint, lower leg, foot
Protection material, such as helmets, safety glasses, hearing protection, or gloves were
not investigated since it was not systematically mentioned in the medical reports. This
query could be investigated in further (prospective) studies.

2.5. Statistical Analysis

The data were summarized using descriptive statistics (mean values, percentages).
The statistical analysis was performed using Stata® 16.1 (StataCorp, The College Station,
TX, USA), which also provided the graphs used to demonstrate our results.
Int. J. Environ. Res. Public Health 2022, 19, 11294 6 of 16

Parameters were classified and presented according to absolute and percentage pro-
portions, including median values. If reasonable and possible based on the information
collected, patients were subdivided and analyzed based on the accident situation, mecha-
nism, or injured body part. Categorical variables were analyzed using the chi-square (χ2 )
test and the Fisher exact test. Group comparisons were performed using Mann–Whitney
test. The threshold of significance was set at p < 0.05 (two-tailed).

2.6. Ethical Approval

Our research project used coded data and was reviewed and approved in advance by
the cantonal ethics committee of Bern (b2022-00455).

2.7. Definitions
In order to categorize patients correctly, a few terms are explained more in detail in
the following section.
Triage levels: Upon presentation in an emergency center in Switzerland, patients are
assigned to different urgency levels according to the Swiss Triage System (Schweizerische
Triage System (STS). The following definitions were extracted from the Swiss Society for
Emergency and Rescue Medicine website [31].
• Urgency level 1 (acute emergency, immediate treatment): Health disorder or imminent
birth that may result in the death of the patient or the loss of a limb, organ, or fetus if
not treated immediately.
• Urgency level 2 (emergency, treatment within 20 min): Health disorder that is not
life-threatening but could worsen within a short time.
• Urgency level 3 (moderately urgent emergency, treatment within 120 min): Health
disorder for which time is not a critical factor. The patient’s condition is judged to be
stable at the time of arrival.
• Urgency level 4 (non-urgent situation): Health condition judged stable that does not
actually require emergency medical therapy.
Location of accident: Different construction sites pose different hazards for workers.
• Building construction site: In order to avoid potentially fatal accidents, Suva recom-
mends different rules: e.g., securing floor openings and fall edges from a fall height
of 2 m immediately, daily scaffolding checks, operating cranes in accordance with
regulations, and attaching loads safely [32].
• Road construction site: Traffic route and civil engineering site workers are exposed to
different dangers such as passing vehicles and heavy machines and loads. Sufficient
visibility and safe accesses are crucial [33].
• Excavation pit: During trenching and excavation work, it is essential to adhere to
certain safety precautions. Otherwise, life danger can quickly arise. In particular,
construction workers can be buried if an embankment is created too steeply or if the
ground is additionally loaded by vehicles, for example [34].

3. Results
3.1. Patient Analysis
3.1.1. Age and Sex Distribution
Between 2016 and 2020, a total of 397 cases aged 16 years or older were identified in
our database as having sustained work-related injuries, while working for a construction
income (Table 1). In our study, patients with occupational injuries were predominantly
male (98.2%). The most represented age group was 26–35 years, with 107 patients (27%,
p < 0.001). In the comparison between the age groups, no statistical differences were
observed for the following parameters: year, month, weekday, and time of consultation,
triage group, route of admission, route of discharge, treatment area, type of trauma, type of
injury, location of injury, mechanism of injury, and treatment method.
Int. J. Environ. Res. Public Health 2022, 19, 11294 7 of 16

Table 1. Distribution of injured body part among construction workers in Switzerland according to
age group.

Total Age Group

(N = 397)
16–25 26–35 36–45 46–55 56–65
Injured body part n (%) (n = 80) (%) (n = 107) (%) (n = 98) (%) (n = 74) (%) (n = 38) (%) p-value
Head 136 (34.3) 33 (41.2) 33 (30.8) 33 (33.7) 20 (27.0) 17 (44.7) 0.209
Head 108 27 28 26 16 11 0.552
(single injury) (27.2) (33.8) (26.2) (26.5) (21.6) (28.9)
Neck, spine 36 (9.1) 6 (7.5) 8 (7.5) 10 (10.2) 7 (9.5) 5 (13.2) 0.826
Neck, spine 13 2 4 2 3 2 13
(single injury) (3.3) (2.5) (3.7) (2.0) (4.1) (5.3)
Thorax, back 30 (7.6) 5 (6.2) 7 (6.5) 10 (10.2) 4 (5.4) 4 (10.5) 0.680
Thorax, back 11 1 3 3 3 1 0.883
(single injury) (2.8) (1.2) (2.8) (3.1) (4.1) (2.6)
Abdomen, pelvis 23 (5.8) 6 (7.5) 6 (5.6) 5 (5.1) 3 (4.1) 3 (7.9) 0.872
Abdomen, pelvis 8 1 3 2 1 1 0.937
(single injury) (2.0) (1.2) (2.8) (2.0) (1.4) (2.6)
Shoulder, upper 43 10 5 13 9 6 0.189
arm, elbow (10.8) (12.5) (4.7) (13.3) (12.2) (15.8)
Shoulder, upper
arm, elbow 23 (5.8) 7 (8.8) 1 (0.9) 5 (5.1) 6 (8.1) 4 (10.5) 0.082
(single injury)
Forearm, wrist,
27 (6.8) 3 (3.8) 8 (7.5) 6 (6.1) 9 (12.2) 1 (2.6) 0.221
carpus
Forearm, wrist,
carpus 19 (4.8) 1 (1.2) 8 (7.5) 5 (5.1) 5 (6.8) 0 (0.0) 0.167
(single injury)
Hand 92 (23.2) 20 (25.0) 23 (21.5) 20 (20.4) 21 (28.4) 8 (21.1) 0.743
Hand 79 16 19 19 18 7 0.864
(single injury) (19.9) (20.0) (17.8) (19.4) (24.3) (18.4)
Hip joint, femur 11 (2.8) 0 (0.0) 3 (2.8) 6 (6.1) 2 (2.7) 0 (0.0) 0.114
Hip joint, femur 8 0 2 5 1 0 0.119
(single injury) (2.0) (0.0) (1.9) (5.1) (1.4) (0.0)
Knee joint,
60 (15.1) 11 (13.8) 23 (21.5) 11 (11.2) 12 (16.2) 3 (7.9) 0.179
lower leg
Knee joint,
lower leg 45 (11.3) 8 (10.0) 17 (15.9) 8 (8.2) 10 (13.5) 2 (5.3) 0.280
(single injury)
Foot 21 (5.3) 4 (5.0) 7 (6.5) 7 (7.1) 2 (2.7) 1 (2.6) 0.637
Foot
15 (3.8) 3 (3.8) 4 (3.7) 6 (6.1) 1 (1.4) 1 (2.6) 0.589
(single injury)
Multiple injured 58 13 13 14 10 8 0.729
body parts (14.6) (16.2) (12.1) (14.3) (13.5) (21.1)

3.1.2. Annual and Seasonal Distribution

Though our data showed a significant difference regarding the annual number of
admissions (p < 0.001), there was no specific trend observed. More specifically, the annual
number of patients varied between 67 and 89, with the fewest incidents in 2018 and the
most in 2019.
In addition, our results showed that there was a significant association between the
treatment area and the year of consultation. More specifically, patients treated in Fast track,
a new treatment area for patients with less-severe injuries [35,36], in 2016 concerned 11.8%
of the cases, whereas for the years 2017–2020 the percentage ranged between 30.03% and
35.4%, indicating an increase.
In the comparison between the analyzed years, no significant differences were ob-
served for the following parameters: age groups, month, weekday, and time of consultation,
triage group, route of admission, and route of discharge. For other variables, significant
differences over time have been found for some categories, but these findings might be
owed to multiple testing. By stratifying according to the season, occupational injuries
among construction workers were found to be significantly higher during summer and
autumn (p < 0.001).

3.1.3. Time and Day of Consultation

The daily time of consultation showed two peaks between 06:00 and 12:00 (n = 148,
37.4%), and between 18:00 and 00:00, without reaching statistical significance. However,
it should be mentioned that despite not being statistically significant the number of con-
sultations between 06:00 and 12:00 was much higher in summer and autumn compared
to winter and spring (194 vs. 56). The frequency of accidents from Monday to Friday was
comparable; however, much less on Saturday and Sunday.
Int. J. Environ. Res. Public Health 2022, 19, 11294 8 of 16

3.1.4. Location and Type of Injury

The most frequently injured body parts were the upper extremities with 162 patients
(40.8%), followed by the head with 136 cases (34.3%, Table 1). The third most common
location of injury was the lower extremities, with 92 cases (23.2%). The hand was the most
frequent location of injury in the upper extremities, with 92 patients (23.2%) (Table 1).
Wound lacerations were the most common type of injury with 190 cases (47.9%),
followed by joint distortions (123 cases; 31%). Seventy-three patients had open (24 cases,
6%) and closed (49 cases, 12.3%) fractures and 32 patients (8.1%) sustained a traumatic
brain injury. Penetration and irritation by foreign objects were identified as the types of
injury in 71 of the cases (17.9%) (Table 2).

Table 2. Distribution of type of injury among construction workers in Switzerland according to age
group.

Total Age Group

(N = 397)

n 16–25 26–35 36–45 46–55 56–65

Type of injury (%) (n = 80) (%) (n = 107) (%) (n = 98) (%) (n = 74) (%) (n = 38) (%) p-value
Wound
laceration, incl. 190 40 54 46 31 19 0.809
pneumothorax, (47.9) (50.0) (50.5) (46.9) (41.9) (50.0)
internal organs
Traumatic brain 32 6 6 14 2 4 0.056
injury (8.1) (7.5) (5.6) (14.3) (2.7) (10.5)
Distortion 123 (31.0) 27 (33.8) 40 (37.4) 25 (25.5) 19 (25.7) 12 (31.6) 0.321
Contusion 84 (21.2) 19 (23.8) 17 (15.9) 25 (25.5) 18 (24.3) 5 (13.2) 0.275
Crush trauma 21 (5.3) 5 (6.2) 4 (3.7) 5 (5.1) 2 (2.7) 5 (13.2) 0.174
Closed fracture 49 (12.3) 6 (7.5) 13 (12.1) 12 (12.2) 12 (16.2) 6 (15.8) 0.528
Open fracture 24 (6.0) 4 (5.0) 5 (4.7) 5 (5.1) 7 (9.5) 3 (7.9) 0.661
Dislocation 6 (1.5) 1 (1.2) 2 (1.9) 2 (2.0) 1 (1.4) 0 (0.0) 0.923
Burn frostbite 5 (1.3) 2 (2.5) 1 (0.9) 1 (1.0) 0 (0.0) 1 (2.6) 0.619
Chemical burn,
electric shock, 7 2 3 1 1 0 0.738
chemical (1.8) (2.5) (2.8) (1.0) (1.4) (0.0)
substances
Infection
poisoning, 2 (0.5) 0 (0.0) 1 (0.9) 1 (1.0) 0 (0.0) 0 (0.0) 0.756
thermal shock
Irritation
mucous 10 (2.5) 2 (2.5) 4 (3.7) 4 (4.1) 0 (0.0) 0 (0.0) 0.341
membranes
Penetration and
irritation of 71 (17.9) 18 (22.5) 22 (20.6) 13 (13.3) 10 (13.5) 8 (21.1) 0.363
foreign objects
Amputation 3 (0.8) 0 (0.0) 0 (0.0) 3 (3.1) 0 (0.0) 0 (0.0) 0.056

Figure 2 depicts the relationship between the injured body part reported and the length
of hospital stay. As shown, accidents related to the neck/spine, thorax/back, abdomen,
and hip resulted in more hospitalization days (approx. up to 10 days) compared to all
other body parts. Within these injuries, extreme outliers were present for the neck/spine,
thorax/back, and abdomen, presumably indicating the severity of injuries related to the
specific body parts.
The majority of patients presented to the Emergency Department with monotrauma
(332 cases, 83.6%), while 44 patients (11.1%) sustained combined injuries without life-
threatening outcome and 11 patients (2.8%) polytrauma with life-threatening injuries.

3.1.5. Mechanisms of Injury

As expected, the majority of the accidents occurred at the construction site (n = 337,
87.1%), whereas for 46 patients (11.9%) the exact location of the accident remained unclear.
Among the 397 occupational injuries of construction workers, the most common
mechanism of injury was falling from a height (87 cases; 21.9%), followed by impact against an
object (69 cases; 17.4%) and trauma due to working with manual instruments (68 cases; 17.1%,
Table 3). To better understand the nature of the accidents among construction workers
we also recorded subgroups related to the type of accidents. In 97 patients (24.4%), the
injury was associated with slippery terrain, followed by accidents causing foreign body
splinters (n = 70, 17.6%). Figure 3 demonstrates the relationship between the mechanism
of injury and the length of hospital stay. By far, being driven into/run over resulted in
 objects
Amputation 3 (0.8) 0 (0.0) 0 (0.0) 3 (3.1) 0 (0.0) 0 (0.0) 0.056

Figure 2 depicts the relationship between the injured body part reported and the
Int. J. Environ. Res. Public Health 2022, 19, 11294
length ofhospital stay. As shown, accidents related to the neck/spine, thorax/back,9ab- of 16

domen, and hip resulted in more hospitalization days (approx. up to 10 days) compared
to all other body parts. Within these injuries, extreme outliers were present for the
neck/spine, thorax/back,
a higher length of hospitaland
stayabdomen, presumably
and was followed indicating
by fall, the severity
manual instrument work,ofentrapment
injuries
bruise, to
related and cutspecific
the on object. parts. for fall, entrapment, and impact against object some extreme
However,
body
outliers were observed
The majority indicating
of patients that to
presented these
the categories
EmergencyofDepartment
injury mechanism could result
with monotrauma
in increased
(332 hospitalwhile
cases, 83.6%), stay under specific(11.1%)
44 patients circumstances.
sustainedNocombined
significantinjuries
differences were
without
observed between mechanism of injury and age group.
life-threatening outcome and 11 patients (2.8%) polytrauma with life-threatening injuries.

Figure 2. Relationship between the injured body part reported and the length of hospital stay. Outliers
are indicated
Figure with symbol
2. Relationship “×”. the injured body part reported and the length of hospital stay.
between
Outliers are indicated with symbol “×”.
Table 3. Distribution of work-related accidents by mechanism of injury among construction workers
in Switzerland
3.1.5. Mechanismsbetween 2016 and 2020.
of Injury
As expected, the majority of the accidents occurred at the construction
Number ofsite (n = 337,
Patients
Mechanism of Injury
87.1%), whereas for 46 patients (11.9%) the exact location of the accident remained
(Total 397) un-
clear. n (%)
Among the 397 occupational injuries of construction workers, the most common
Fall 87 (21.9)
mechanism of injury was falling handling
Machine from a height (87 cases; 21.9%), followed
40 by impact(10.1)
against
an object (69 cases; 17.4%) andinstruments
Manual trauma due to working with manual instruments
68 (68 cases;
(17.1)
17.1%, Table 3). ToDriving
better understand the nature of the accidents among
a transport vehicle 3 construction
(0.8)
workers we also recorded Transport 11
by handrelated to the type of accidents.
subgroups (2.8)
In 97 patients
Moving, walking, running, climbing, tripping 32
(24.4%), the injury was associated with slippery terrain, followed by accidents causing (8.1)
Contaminating substances 13 (3.3)
Explosion, ignite burn, electrical contact 8 (2.0)
Driven into, run over 2 (0.5)
Entrapment bruise 42 (10.6)
Impact against object 69 (17.4)
Cut on an object 18 (4.5)
 Contaminating substances 13 (3.3)
Explosion, ignite burn, electrical contact 8 (2.0)
Driven into, run over 2 (0.5)
Entrapment bruise 42 (10.6)
Int. J. Environ. Res. Public HealthImpact
2022, 19, against
11294 object 69 (17.4)10 of 16
Cut on an object 18 (4.5)

Figure 3. Relationship between the mechanism of injury and length of hospital stay. Outliers are
Figure 3. Relationship between the mechanism of injury and length of hospital stay. Outliers are
indicated with symbol “×”.
indicated with symbol “×”.
Figure
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER 4 summarizes
REVIEW the relationship between the mechanism of injury 11 and
of 17the mode
Figure 4 summarizes
of discharge. the relationship
All cases reporting contaminated between
substancestheasmechanism
the mechanismof injury and were
of injury the
mode of discharge. All cases reporting contaminated substances as the mechanism
discharged from the hospital and treated at home. The same pattern was observed for of injury
were discharged
transport by hand from the hospital
and driving and vehicle,
a transport treated and
at home.
a veryThe same
similar pattern
pattern waswas observed
observed for
served
for for moving.byAlthough
transport hand for cut on object, machine handling, andvery
entrapment bruise, thewas ob-
moving. Although forand
cut driving a machine
on object, transport vehicle,
handling, and
and aentrapment
similar pattern
bruise, the majority of
majority of the cases were also discharged home, for some cases (approx., above 40%)
the cases were also discharged home, for some cases (approx., above 40%) hospitalization
hospitalization was required. However, and in contrast to all other mechanisms of injury,
was required. However, and in contrast to all other mechanisms of injury, in one case
in one case entrapment bruise led to a fatal outcome. Finally, for driven into/run over acci-
dents half of the bruise
entrapment ledwere
patients to adischarged
fatal outcome.
home, Finally, drivenhalf
for other
while the into/run over accidents half of
were hospitalized,
the patients were discharged home, while the other half were
suggesting that these types of accidents may result in more severe injuries. hospitalized, suggesting that
these types of accidents may result in more severe injuries.

Figure 4. Relation between mechanism of injury and mode of discharge.

Figure 4. Relation between mechanism of injury and mode of discharge.

3.1.6. Treatment
The most common type of treatment was conservative (244 cases; 61.5%), whereas 85
(21.4%) and 56 (14.1%) patients received minimal invasive and operative treatment, re-
Int. J. Environ. Res. Public Health 2022, 19, 11294 11 of 16

3.1.6. Treatment
The most common type of treatment was conservative (244 cases; 61.5%), whereas
85 (21.4%) and 56 (14.1%) patients received minimal invasive and operative treatment,
respectively. Patients treated conservative in 2016 concerned 50% of the cases, whereas
for the years 2017–2020 the percentage ranged between 62.2% and 66.3% indicating an
increase.

3.1.7. Admission and Discharge

By far, the largest number of patients were walk-in patients (315; 79.3%), followed
by ambulance transfers (39; 9.8%). The majority of patients were discharged from the ED
(334; 84.1%). Fifty-nine patients (14.9%) were hospitalized as in-patients and three (0.8%)
patients were transferred to another hospital. One 57-year-old patient was transferred from
another hospital by polytrauma and passed away in the ED under reanimation.
With respect to the Swiss Emergency Triage Scale, the majority of patients (303; 76.3%)
had urgent triage, followed by emergent (65; 16.4%) triage. Twenty-one patients (5.3%) had
such a severe injury that they were triaged as very emergent.
No significant differences were observed between route of admission, route of discharge,
and triage in relation to age group, season, or year of consultation.

4. Discussion
This study identified 397 patients who sustained occupational injuries while working
for a construction income and were covered by Suva insurance, the Swiss Accident Insur-
ance Fund. Consistent with previous studies, our research shows a predominance of male
patients [37,38], and is in accordance with statistics showing that persons suffering from
these types of injuries are males in 98% of the cases [37]. This is not surprising, considering
that males, due to the nature of the job, are more frequently employed in high-risk sectors
(e.g., construction industries and manufacturing) compared to females [39]. The most rep-
resented age class was 26–35 years old. This is in contrast with other studies demonstrating
that young workers sustained a higher risk of work-related injuries due to the shorter
duration of occupation and the associated inexperience, less awareness about occupational
hazards, and risk-taking behavior [40,41].
Moreover, our study identified a significantly increased risk of work-related injury
among construction workers during the warm season (e.g., summer and autumn), which is
in accordance with studies from neighboring countries and suggests an association between
increased risk of occupational injuries and higher environmental temperatures [27,42–44].
However, this may largely be due to more construction activities taking place in the warmer
season. In addition, construction workers are at enhanced risk of heat-related injuries due
to the handling of heavy machinery, power tools, and heavy workloads, factors which
act synergistically with the direct sunlight exposure in causing heat-related illness [45].
However, despite the association between high environmental temperatures and work-
related injuries being complex, it is well established that the extreme temperature exposure
contributes significantly to reduced productivity, fatigue, carelessness, impaired judgment,
poor coordination, loss of concentration, and disorientation increasing the risk of accidental
events [46–48].
The majority of work-related injuries in our study resulted from a fall (21.9%) and
were followed by impact against an object (17.4%) and trauma due to working with manual
instruments (17.1%). Our findings are in line with previous evidence which highlights that
falls are the leading mechanism of injury among construction workers [49–52]. Moreover,
previous research suggests that human behavior, workplace conditions, safety performance,
and the nature of activity might be causal factors for accidents associated with occupational
falls [53]. In addition, various parameters such as carelessness, overconfidence, and incor-
rect evaluation of the height are described as leading causes of work-associated accidents
due to falls [54]. Furthermore, other studies have shown that gender and age have an
epidemiological association with occupational injuries due to falls [55,56]. In our study,
Int. J. Environ. Res. Public Health 2022, 19, 11294 12 of 16

only 16% of accidents occurred in the age group between 16 and 25 years of age, and thus
inexperience, risk-taking behavior, and physical vulnerability do not appear as the main
contributing factors.
In the present study, the most common body parts injured were the upper extremities,
with the hand being the most frequent location of the injury, in accordance with numer-
ous studies describing the upper extremities as the most commonly affected body part
[57,58]. Unlike previous evidence indicating lower extremities as the second-most-frequently
injured body part [51,59], the results of the present study indicate that it is rather the head,
followed by the lower extremities. This finding is concerning, given that a pooled propor-
tions meta-analysis demonstrated that 17.9% of traumatic brain injuries are work-associated
and 6.3% of occupational events result in traumatic brain injury (TBI) with 3.6% of work-
related TBI being fatal [60]. Interestingly, 77 patients (19.4%) in our study were treated in
the ophthalmology area due to eye injury, which is in accordance with numerous studies
describing eye injury as a frequent work-related injury representing 30% to 70% of the con-
sultations of the Ophthalmological Emergency Department [61–63]. In addition, it is well
documented that the majority of patients with work-related eye injuries are construction
workers [62,64], indicating the significance of optimizing prevention strategies and safety
performance in the construction sector. In our analysis, the most common type of injury
was wound lacerations (47.9%), followed by joint distortions (31%) and bone fractures
(18.3%). These results confirm previous studies reporting that wound lacerations, sprains
and strains, and fractures are frequently observed types of injury among construction
workers [23,58,65]. Moreover, as shown in Figure 2, accidents related to the neck/spine,
thorax/back, abdomen, and hip resulted in more hospitalization days (approx. up to
10 days) compared to all other body parts. Within these injuries, extreme outliers were
present for the neck/spine, thorax/back, and abdomen, presumably indicating the severity
of injuries related to the specific body parts. Taking into account that falls are the leading
mechanism of injury in the context under examination, protective equipment targeting the
extremities and head is strongly suggested.
In contrast with other studies demonstrating a higher risk of occupational injuries
during the afternoon and night-shifts [66], two peaks of a daily time of consultations
between 06:00 and 12:00 and between 18:00 and 00:00 were observed in our study, indicating
that the majority of accidents occurred in the morning- and early-afternoon shifts. A
possible explanation for this finding is that construction employees commonly suffer from
pain, fatigue, uncontrolled stress, and other special diseases leading to sleep irregularities
[67–70], for example irregular sleep patterns and lower sleep efficiency [71,72]. Moreover,
the finding that the number of consultations due to construction accidents between 06:00
and 12:00 is much higher in the warm year period indicates a climate influence. Indeed,
extreme environmental temperatures can result in cognitive disturbances such as loss of
concentration and disorientation, contributing to the enhanced risk of injury observed in
the present study [47]. Additionally, exposure to heat can lead to dehydration and sweaty
palms, both serving as risk indicators for occupational injuries [46].
Considering the severity of the injuries, our data show that the proportion of severe
injuries is relatively low and comparable to that previously reported [38]. Indeed, only 9.8%
of the patients had to be transferred by ambulance, whereas 79.3% were walk-in patients.
Moreover, the majority of the patients (76.3%) was assessed as “urgent” triage. Only 5.3%
of the patients had such a severe injury requiring immediate examination. In addition,
most of the patients received conservative treatment (244 cases; 61.5%), whereas 85 (21.4%)
and 56 (14.1%) patients received minimal invasive and operative treatment. Finally, 84.1%
of the patients were discharged home, while only 14.9% of the cases had to be hospitalized,
and 0.8% were transferred to another hospital.
Despite the strengths of our research, some limitations should be taken into con-
sideration. Specifically, the present study was a single-center study. Injuries related to
construction accidents treated in other emergency departments, private physicians’ prac-
tices or not treated injuries were not recorded. Moreover, a number of important variables
Int. J. Environ. Res. Public Health 2022, 19, 11294 13 of 16

such as level of education and work experience, socioeconomic characteristics, and type
of occupation (e.g., permanent, part-time, casual, work in a shift-model) were unfortu-
nately not available. Another limitation was the absence of information of using personal
protective equipment and whether safety training had been completed. Furthermore, con-
struction workers who are employed by foreign companies are not covered by Suva and
therefore excluded, as well as patients who have not been employed at all, i.e., had an
accident on their own, private construction site. Additionally, long-term follow-up data
offering supplemental information regarding health costs and persistence of disability were
not included in our study. Finally, for some cases data were incomplete or missing.

5. Conclusions
Work-related accidents in the construction sector create a globally significant burden
of disability and have devastating socioeconomic effects. However, many of them could be
preventable by the optimized development of prevention strategies and safety measures.
Our results demonstrate that the upper and lower extremities and head are common loca-
tions of injuries among construction workers indicating that accurate protective equipment
targeting the extremities, eyes, and head is crucial. Moreover, similar to other studies, we
identified falls as the leading mechanism of injury leading to strongly recommend primary
and secondary improvement of fall prevention. In addition, this study demonstrates that
accidental events in the construction sector occur frequently in the warm seasons of the
year. Taking into account that the construction sector is highly affected by environmental
parameters and that severe weather events are expected to increase due to climate change,
it is very important to establish active prevention policies. In order to be conclusive about
the possible causes of construction-related accidents more studies are needed focusing on
both, local and national levels, and adopting standardized assessment tools. Finally, future
studies should additionally strive to track and record cases treated in physicians’ practices
and untreated cases to gain more insight into the actual prevalence of these injuries and
their possible causes.

Author Contributions: Conceptualization, J.K.-R., S.M.S. and M.Z.; methodology, J.K.-R., M.M. and
S.M.S.; validation, J.K.-R., M.M. and M.Z.; formal analysis, R.D., L.O., M.M., S.M.S. and M.Z.; data
curation, M.Z.; writing—original draft preparation, R.D., L.O. and M.Z.; writing—review and editing,
J.K.-R. and M.Z.; visualization, M.M., S.M.S. and M.Z.; supervision, J.K.-R., A.K.E. and M.Z.; project
administration, J.K.-R. and M.Z. All authors have read and agreed to the published version of the
manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Our research project used coded data and was reviewed and
approved in advance by the cantonal ethics committee of Bern (b2022-00455).
Informed Consent Statement: No specific consent was obtained for this study.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest. One of the authors (S.M.S.) works
for Suva, a public accident insurance company. Suva had no role in the design of the study; in the
collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to
publish the results.

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